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Tonsillitis

Definition

Tonsillitis is inflammation (swelling) of the tonsils.

See also:

• Sore throat
• Strep throat

Causes, incidence, and risk factors

The tonsils are lymph nodes in the back of the mouth and top of the throat. They normally help to filter out bacteria and other germs to prevent infection in the body.

Strep throat is one cause of tonsilitis.

The tonsils may become so overwhelmed by a bacterial or viral infection that they swell and become inflamed, causing tonsillitis. The infection may also be present in the throat and areas around it, causing inflammation of the pharynx. The pharynx is in the back of the throat, between the tonsils and voicebox (larynx). See: Pharyngitis

Tonsillitis is very common, especially in children.

Symptoms

• Difficulty swallowing
• Ear pain
• Fever, chills
• Headache
• Sore throat - lasts longer than 48 hours and may be severe
• Tenderness of the jaw and throat
• Voice changes, loss of voice

Signs and tests

The health care provider will look in the mouth and throat for swollen tonsils. The tonsils are usually red and may have white spots on them. The lymph nodes in the jaw and neck may be swollen and tender to the touch.

Tests that may be done include:

• Blood count
• Mononucleosis test
• Rapid strep test
• Throat swab culture

Treatment

If bacteria such as strep are causing the tonsillitis, antibiotics are given to cure the infection. The antibiotics may be given once as a shot, or taken for 10 days by mouth.

If antibiotic pills are used, they must be taken for the entire amount of time prescribed by the doctor. DO NOT stop taking them just because the discomfort stops, or the infection may not be cured.

Other treatments include:

• Drink cold liquids or suck on popsicles
• Drink fluids, especially warm (not hot), bland fluids
• Gargle with warm salt water
• Suck on lozenges (containing benzocaine or similar ingredients) to reduce pain (these should not be used in young children because of the choking risk)
• Take over-the-counter medications, such as acetaminophen (Tylenol) or ibuprofen to reduce pain and fever. Do NOT give a child aspirin. Aspirin has been linked to Reye syndrome.

Some people who have repeated infections may need surgery to remove the tonsils (tonsillectomy).

Support Groups

Expectations (prognosis)

Tonsillitis symptoms usually improve 2 or 3 days after treatment starts. The infection usually is cured after treatment is completed, but some people may need more than one course of antibiotics.

Complications of untreated strep tonsillitis may be severe. Children with tonsillitis related to strep throat or pharyngitis should generally be kept home from school or day care until they have been on antibiotics for 24 hours. This helps reduce the spread of illness.

Complications

• Blocked airway from swollen tonsils
• Dehydration from difficulty swallowing fluids
• Kidney failure
• Peritonsillar abscess or abscess in other parts of the throat
• Pharyngitis - bacterial
• Post-streptococcal glomerulonephritis
• Rheumatic fever and related cardiovascular disorders

Calling your health care provider

Call your health care provider if there is:

• Excess drooling in a young child
• Fever, especially 101°F or higher
• Pus in the back of the throat
• Red rash that feels rough, and increased redness in the skin folds
• Severe difficulty swallowing or breathing
• Tender or swollen lymph glands in the neck

References

Wetmore RF. Tonsils and adenoids. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 380.

Del Mar CB, Glasziou PP, Spinks A. Antibiotics for sore throat. Cochrane Database Syst Rev. 2008:(3):CD000023.

Chan TV. The patient with sore throat. Med Clin North Am. 2010. 94:923-943.